Thrombolytics in pulmonary embolism

Free-floating right heart thrombus (RHT) is an extreme medical emergency in the context of acute massive pulmonary embolism (PE). Despite the advances in early diagnosis, the management is still very debatable due to lack of consensus. We reported the case of a 66-year-old male, with a history of moderate renal dysfunction and dilated cardiomyopathy, who presented to the emergency department for acute dyspnea. His angiographic magnetic resonance imaging revealed bilateral extensive PE. Transthoracic echocardiography showed RHT with moderate right ventricular dysfunction and pulmonary hypertension...

BACKGROUND: Immortal time bias is a possible confounding factor in cohort studies. In this investigation, we assessed mortality with inferior vena cava (IVC) filters in unstable patients with pulmonary embolism using a design that eliminated immortal time bias. METHODS: Data are from Premier Healthcare Database, 2010-2014. International Classification of Disease-9th Clinical Modification codes were used. Unstable patients with pulmonary embolism and an admitting diagnosis of pulmonary embolism as well as a primary diagnosis of pulmonary embolism were included...

PURPOSE: Current literature on clinical controversies surrounding the use of thrombolytic agents in patients with intermediate-risk pulmonary embolism (PE) is reviewed. SUMMARY: PE is a major cause of morbidity and mortality. When used in conjunction with anticoagulation, thrombolysis has been shown to reduce hemodynamic decompensation in select patients, but thrombolytic therapy is associated with high risks of bleeding and intracranial hemorrhage and its role in treating patients with intermediate-risk PE remains controversial...

Carbon monoxide (CO) poisoning, the most frequent type of poisoning, alters hemodynamics and creates tissue hypoxia that ultimately leads to thromboembolism. We herein describe a previously healthy 17-year-old male patient who developed acute CO poisoning while bathing in the same room as a gas heater. He was first treated with urokinase thrombolytic therapy at a local hospital, which proved ineffective. The patient was admitted to our hospital with unstable circulation and was diagnosed with massive pulmonary embolism combined with multiple organ dysfunction syndrome...

Anticoagulants are the standard form of treatment used in deep vein thrombosis (DVT). Thrombolytic therapy is another method to treat thromboembolism by using intravenous administration of streptokinase, urokinase and recombinant tissue plasminogen activator (r-tPA). We have investigated the effect of r-tPA, a systemic thrombolytic used for the treatment of pulmonary emboli, on DVT in the same patients. 130 patients who were diagnosed with both pulmonary embolism and DVT were included in this study. Lower extremity Doppler ultrasonography (DUS) was conducted on all of the patients upon admission and then on the 6th month...

PURPOSE: The dosing and administration of alteplase in cardiac arrest due to suspected or confirmed pulmonary embolism (PE) are characterized. METHODS: This multicenter, retrospective, cohort study evaluated adult patients who received alteplase during PE-induced cardiac arrest at 16 medical centers. Outcomes analyzed included alteplase dosing characteristics, cardiopulmonary resuscitation survival, time to return of spontaneous circulation (ROSC), documented occurrence of major or minor bleeding, intensive care unit and hospital length of stay, and survival to discharge...

The risk of thromboembolism is higher in those with carbon monoxide (CO) poisoning than in the general population. Pulmonary embolisms (PE) usually develop during admission for acute CO poisoning. We report the first case of a life-threatening PE that occurred immediately after acute CO poisoning and was treated with a thrombolytic agent. A 38-year-old woman presented at the emergency department with a stuporous mental status immediately after acute CO poisoning. She was started on hyperbaric oxygen therapy (HBOT), which maintained her hemodynamic stability...

Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality in the United States. PE associated with right ventricular strain, termed submassive or intermediate-risk PE, is associated with an increased rate of clinical deterioration and short-term mortality. Trials have demonstrated systemic thrombolytics may improve patient outcomes, but they carry a risk of major hemorrhage. Catheter-directed thrombolysis (CDT) may offer similar efficacy to and a lower risk of catastrophic hemorrhage than systemic thrombolysis...

Objectives The aim was to assess the effectiveness and safety of catheter-directed thrombolysis in children with deep venous thrombosis and to evaluate its long-term effect. Method and results EMBASE, Medline and Cochrane databases were searched to identify studies in which paediatric acute deep venous thrombosis patients received thrombolysis. Following title and abstract screening, seven cohort studies with a total of 183 patients were identified. Technical success was 82% and superior in regional rather than systemic thrombolysis (p < 0...

A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST elevations in leads V1-V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction...

Pulmonary embolism is associated with significant mortality and impaired long-term functional outcomes. Timely identification and treatment is crucial for successful management. Unfortunately, prompt diagnosis can be challenging in patients without overt signs of cardiovascular compromise. Point-of-care cardiac ultrasound (POCCUS) can be used to identify signs of acute pulmonary embolism, risk stratify patients for adverse outcomes and assess response to therapy. This report describes a patient with submassive pulmonary embolism and evidence of acute right ventricular strain on POCCUS successfully treated with thrombolytic therapy...

Massive pulmonary embolism (PE) frequently leads to cardiac arrest (CA) which carries an extremely high mortality rate. Although available, randomized trials have not shown survival benefits from thrombolytic use. Thrombolytics however have been used successfully during resuscitation in clinical practice in multiple case reports and in retrospective studies. Recent resuscitation guidelines recommend using alteplase for PE related CA; however they do not offer a standardized treatment regimen. The most consistently applied approach is an intravenous bolus of 50 mg tissue plasminogen activator (t-PA) early during cardiopulmonary resuscitation (CPR)...

The impact of adherence to published guidelines on the outcomes of patients with acute pulmonary embolism (PE) has not been well defined by previous studies.In this prospective cohort study of patients admitted to a respiratory department (n=2096), we evaluated whether patients with PE had better outcomes if they were acutely managed according to international guidelines. Outcomes consisted of all-cause mortality, PE-related mortality, recurrent venous thromboembolism (VTE) and major bleeding events during the first month of follow-up after diagnosis...

RATIONALE: Acute pulmonary embolism (APE) as a life-threatening illness may present with a wide range of manifestations. APE was diagnosed using computed tomographic pulmonary angiography (CTPA); however, transthoracic echocardiography (TTE) can reveal hemodynamic status. Early thrombolysis is the most effective therapy for the treatment of massive pulmonary embolism. PATIENTS CONCERNS: Herein, we report a case of high-risk APE with a wide range of manifestations, including chest pain, dyspnea, low-blood pressure, and syncope...

Perioperative pulmonary embolism can go undetected until the sudden onset of cardiopulmonary collapse. Point of care echocardiography in such setting can narrow the differential diagnosis of precipitous instability and facilitate tailored, rather than empiric, therapy in the event of a massive pulmonary embolism. We describe the diagnosis and successful multidisciplinary management of intraoperative massive pulmonary embolism aided by both transthoracic and transesophageal echocardiography. Key aspects regarding the classification and treatment of pulmonary embolism are subsequently reviewed...

We report the case of a 31-year-old female who was admitted to the emergency department with symptoms of cardiac arrest and ultimately died in spite of enormous resuscitation efforts. During resuscitation, pulmonary embolism was considered as a possible non-cardiac cause of cardiac arrest, and following its extremely unfavorable prognosis, the fatal outcome was not so surprising. However, since acute pulmonary emboli obstructing blood flow to a lobe or multiple lung segments was suspected, alteplase was indicated and administered...

OBJECTIVE: To critically evaluate the published literature assessing the safety and efficacy of thrombolytic therapy for massive and submassive pulmonary embolism (PE). METHODS: A search of human trials in the English-language (September 2017) was conducted through the MEDLINE database using the following terms: PE, tissue plasminogen activator, tenecteplase, and alteplase. 67 unique articles were identified, of which 24 clinical trials discussing clinical outcomes related to administration of either intravenous tenecteplase or alteplase were included...

BACKGROUND: Syncope and pre-syncope are well-known symptoms of acute pulmonary embolism (PE). However, data about their impact on short-term mortality are scant. We assess the short-term mortality (30-day) for all-causes in PE patients admitted with syncope or with pre-syncope, according their hemodynamic status at admission. METHODS: Patients from the prospective Italian Pulmonary Embolism Registry (IPER) were included in the study. At admission, subjects were stratified according to 2008 ESC guidelines (as high- and non-high-risk patients)...

A 43-year-old apparently healthy male presented with fever and presyncope. He was suspected to have massive pulmonary thromboembolism based on the clinico-biochemical profile. Despite aggressive thrombolytic therapy, he succumbed to his illness within 12 h of admission. Postmortem examination showed massive pulmonary thromboembolism and hyperhomocysteinemia with low high-density lipoproteins (HDL) cholesterol with antemortem blood sample. Herein, we report autopsy findings in a rare case of a young male with occult massive pulmonary thromboembolism without deep vein thrombosis, who had an atypical clinical presentation and was found to have underlying hyperhomocysteinemia and decreased HDLc...

Thrombolysis and anticoagulation were the main treatment methods for acute pulmonary embolism. However, the use of thrombolysis drugs may lead to bleeding complications. We compared intermittent low-dose urokinase (UK) and alteplase (recombinant tissue plasminogen activator [rt-PA]) in normotensive patients with intermediate-high-risk pulmonary embolism. The UK group was treated with intravenous UK 10 000 U/kg once a day for 7 days. The rt-PA group was given alteplase 50 mg by intravenous injection within 2 hours of admission...